Enhancing Surgical Care in BC - British Columbia Medical Association


Enhancing Surgical Care in BC - British Columbia Medical Association

United Kingdom

In 2009 the National Health Service (NHS) launched The Productive Operating Theatre (TPOT) Programme, designed

to train and empower perioperative personnel with the knowledge and practical tools needed to improve surgical

programs in their respective hospitals. TPOT provides a comprehensive package of foundation and training modules

derived from Lean methodology, and is aimed at addressing specific operating room issues and processes (e.g.,

organization of the OR, patient preparation, scheduling, communication).

The program modules are used by staff to review each perioperative component with a structured approach to

help identify issues, then test, implement, and measure appropriate changes. The modules are also used by senior

executive hospital leaders to determine what leadership, engagement, and support is necessary to ensure the initiative

is successful in their hospitals. TPOT also provides structured train-the-trainer sessions and on-site implementation

support. While the program is still relatively new, participating hospitals have self-reported improvements in the

following ways:

Enhancing the safety culture, improving communication, and reducing errors by implementing structured

briefing and debriefing, the WHO safety checklist, and better OR staff teamwork.

• Improving efficiency and productivity by focusing on operating start time, turnaround time, more effective

utilization of operating room, and staff resources.

• Realizing financial savings by eliminating waste and making processes more efficient through standardization.

For example, a minimum £5,000 (~$8,000 CDN) in stock reduction per OR and a minimum £9,000 (~$14,000

CDN) in recurring annual saving per OR was realized on consumables.

According to the NHS, TPOT’s success is based on the fact that the perioperative teams themselves identify the

problems and implement the solutions. Since the changes are specifically relevant to staff, they are more likely to be

sustained. TPOT is now being implemented in hospitals throughout England, Wales, and Scotland, as well as in New

Zealand. In Canada, most recently Saskatchewan has taken interest in adopting its use (Saskatchewan Ministry of

Health, 26 November 2010).


As part of Ontario’s 2004 Wait Time Strategy, the Ministry of Health and Long-Term Care established the Surgical Process

Analysis and Improvement (SPAI) Expert Panel, along with several other expert panels. The SPAI Expert Panel was made

up of leaders in health care administration, perioperative processes, surgery, materials management, and academia. It

developed a comprehensive perioperative improvement plan for the province that included advice on accountability

frameworks; mapping of perioperative processes; benchmark and best practice targets, information technology,

and management; human resources; education; funding; and organization of regional surgical services to increase


As part of the implementation strategy, the Surgical Efficiency Targets Program (SETP) was established and key

performance indicators related to surgical process efficiency were developed (e.g., first-case on-time start, turnover

time, scheduling accuracy, case cancellations). The list of indicators is identified in Exhibit 4.

Standard data on operating room performance are now collected by each hospital and used by the Ministry, Local

Enhancing Surgical Care in BC – Part 3: Process Improvement Initiatives in Other Jurisdictions 22

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